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  • 1
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    Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation and coexistent atrial fibrillation
    Oxford University Press (OUP) ; 2021
    In:  European Heart Journal Vol. 42, No. 20 ( 2021-05-21), p. 2019-2019
    Details
    In: European Heart Journal, Oxford University Press (OUP), Vol. 42, No. 20 ( 2021-05-21), p. 2019-2019
    Type of Medium: Online Resource
    ISSN: 0195-668X , 1522-9645
    URL: Article
    DOI: 10.1093/eurheartj/ehaa906
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
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  • 2
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    The revolution of the anti-diabetic drugs in cardiology
    Oxford University Press (OUP) ; 2020
    In:  European Heart Journal Supplements Vol. 22, No. Supplement_E ( 2020-06-01), p. E162-E166
    Details
    In: European Heart Journal Supplements, Oxford University Press (OUP), Vol. 22, No. Supplement_E ( 2020-06-01), p. E162-E166
    Abstract: Beginning in December 2008, under the auspices of Food and Drug Administration, numerous controlled clinical trial were planned, and in part completed, concerning the cardiovascular (CV) effects of hypoglycaemic drug in patients with Type 2 diabetes mellitus. At least 9 studies have been concluded, 13 are still open, and 4 have been initiated and closed ahead of time. Of the nine completed studies, three concerned inhibitor of the dipeptidyl peptidase 4 (inhibitors of DPP-4), four the glucagon-like peptide 1 agonist (GLP-1 agonist), and two the inhibitor of sodium-glucose co-transporter-2 (inhibitors of SGLT-2). Only four studies demonstrated the superiority, and not the mere ‘non-inferiority’, of the anti-diabetic drugs compared to placebo, in addition to standard treatment, in terms of reduction of the primary endpoint (CV death, non-fatal myocardial infarction, and non-fatal stroke). Two of the four studies regarded GLP-1 analogues (liraglutide and semaglutide), and two inhibitors of SGLT-2 (empaglifozin and canaglifozin). As a whole, these studies provided solid data supporting major beneficial CV effects of anti-diabetic drugs. During the next 3–4 years, an equal number of studies will be completed and published, so we will soon have the ‘final word’ on this issue. In the meantime, the clinical cardiologist should become familiar with these drugs, selecting the patients able to gain the best clinical advantage from this treatment, also by establishing a close relationship with the diabetologist.
    Type of Medium: Online Resource
    ISSN: 1520-765X , 1554-2815
    URL: Article
    DOI: 10.1093/eurheartj/suaa084
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
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  • 3
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    405 Myopericarditis after SARS-CoV-2 MRNA vaccination: casual or causal relationship?
    Oxford University Press (OUP) ; 2021
    In:  European Heart Journal Supplements Vol. 23, No. Supplement_G ( 2021-12-08)
    Details
    In: European Heart Journal Supplements, Oxford University Press (OUP), Vol. 23, No. Supplement_G ( 2021-12-08)
    Abstract: Myopericarditis have been reported as rare event after SARS-CoV-2 vaccination with mRNA-1273 and BNT162b2. However, these data referred to the month of May 2021, when only a few people under the age of 30 had been vaccinated. The aim was to report cases diagnosed with myopericarditis short after vaccination admitted to our hospital. Methods and results An observational study was performed recording all cases of patients (pts) hospitalized for myopericarditis which occurred within 14 days of SARS-CoV-2 mRNA vaccination. From June to August 2021, 12 pts were hospitalized for myopericarditis; four of them (33%) were young male pts (29 ± 12 years old) with no history of CVDs or SARS-CoV-2 infection but with a recent second dose of Covid-19 mRNA-1273 vaccine (mean interval from the injection 3 ± 2 days). ECG showed diffuse ST-segment elevation without specularity (Figure 1). SARS-CoV-2 molecular swab tested negative; laboratory (lab) test showed a slight increase of white blood cells (11 267 ± 1047 108/l) and a marked increase of C-reactive protein (78 ± 79 mg/l), troponin T (179 ± 179 ng/l), and Nt-proBNP (876 ± 198 ng/l); transthoracic echocardiogram showed normal left ventricle ejection fraction (mean 55 ± 3%) and in one case only mild pericardial effusion; chest X-ray showed pleural effusion in one case only. Pts were then hospitalized for an average of 7 ± 2 days and an anti-inflammatory therapy based on acetylsalicylic acid and colchicine (in one case also with cortisone) was established. In the following days, pts gradually recovered and were discharged home. After 10 days, two pts underwent a cardiac magnetic resonance imaging (cMRI) revealing myocardial oedema and late gadolinium enhancement in the subepicardial and midmyocardium, along the basal and mid-apical lateral wall; due to relative contraindications, the same examination was scheduled later for the other two pts. These cases deserve specific considerations on the causal relationship between heart inflammation and SARS-CoV-2 mRNA vaccines. Among the various pathophysiological hypothesis there is the high levels of antibodies that mRNA vaccines can generate in young male subjects or the consideration of mRNA as a natural adjuvant capable of activating disproportionately the innate immune system; in both cases, the result is an immune overreaction that can affect various organs including the heart. Conclusions Although the number of our cases is small and all pts recovered in a short time, the timing of symptoms and the similarities in clinical findings and lab characteristics call for further investigations.
    Type of Medium: Online Resource
    ISSN: 1520-765X , 1554-2815
    URL: Article
    DOI: 10.1093/eurheartj/suab135.025
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
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  • 4
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    404 Acute coronary syndromes after healing from COVID-19: report of the initial observation
    Oxford University Press (OUP) ; 2021
    In:  European Heart Journal Supplements Vol. 23, No. Supplement_G ( 2021-12-08)
    Details
    In: European Heart Journal Supplements, Oxford University Press (OUP), Vol. 23, No. Supplement_G ( 2021-12-08)
    Abstract: Severe pulmonary complications are well described in the coronavirus disease 2019 (COVID-19) and cardiovascular diseases (CVDs) have been documented as well. Most patients (pts) recover quickly; nevertheless, the potential long-term cardiovascular sequalae of COVID-19 remain currently unknown. The aim was to report cases of acute coronary syndromes (ACS) after healing from COVID-19 and their features at coronary angiography; secondary purpose was to hypothesize the underlying mechanisms. Methods and results A retrospective study was performed by acquiring data from the electronic medical record. From January to June 2021, four hypertensive pts (64 ± 17 years old; three males) with no history of CVDs and previous symptomatic SARS-CoV-2 infection (mean interval from first positive molecular swab 47 ± 32 days; all recovered after 15 days with double negative swab) were admitted to the emergency department for ST-elevation myocardial infarction (3 anterior and one inferior). At admission, the SARS-CoV-2 molecular swab tested negative, left ventricle ejection fraction was 42 ± 12%, troponin T and Nt-proBNP values were 47 ± 24 ng/l and 1180 ± 978 ng/l, respectively. Emergency coronary angiography showed single-vessel acute thrombotic occlusion (in three cases of the anterior descending artery and in one case of the right coronary artery), with no evidence of atherosclerotic disease. Because of the high thrombotic burden, in all cases a mechanical thrombus aspiration system was used, tirofiban infusion started and no balloon angioplasty or drug-eluting stent implantation was necessary (Figures A–D). After 72 h, a second SARS-CoV-2 molecular swab tested also negative. In the following days, the pts gradually recovered and they were discharged home. Conclusions These cases deserve specific considerations both on the pathophysiologic mechanisms of the ACS possibly related to SARS-CoV-2 and on the subsequent long-term sequelae. Among various pathophysiologic mechanisms proposed, the high affinity of the spike protein for the angiotensin converting enzyme two receptor (expressed by both cardiac and endothelial cells) could explain direct cardiac viral infection and vasculitis with possible development of thrombosis. The latter could contribute both to acute and long-term cardiac sequelae, even months after the acute infection, configuring a sort of ‘cardiac post-Covid syndrome’. Whether and how long this status persists, making COVID-19 a risk factor for subsequent CVDs, is still an unresolved question. In this regard, continuous monitoring of these pts and larger future studies will be essential.
    Type of Medium: Online Resource
    ISSN: 1520-765X , 1554-2815
    URL: Article
    DOI: 10.1093/eurheartj/suab135.024
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
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  • 5
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    Therapy of Type 2 diabetes: more gliflozines and less metformin?
    Oxford University Press (OUP) ; 2023
    In:  European Heart Journal Supplements Vol. 25, No. Supplement_B ( 2023-04-21), p. B171-B176
    Details
    In: European Heart Journal Supplements, Oxford University Press (OUP), Vol. 25, No. Supplement_B ( 2023-04-21), p. B171-B176
    Abstract: Metformin is a frequently used anti-diabetic drug. In addition to the well-known modulating properties on glyco-metabolic control, metformin reduces cardiovascular (CV) risk partly independently of its anti-hyperglycaemic effect. The use of ‘new’ anti-diabetic drugs, inhibitors of the renal Na-glucose co-transporter (SGLTs-I or ‘gliflozines’) and GLP-1 receptor agonists (GLP1-RAs), has further contributed to challenge the strictly ‘gluco-centric’ view of diabetic CV disease. Several controlled trials have demonstrated that the cardio-renal benefits of gliflozines and GLP1-RAs are present regardless of the presence of metformin as ‘background’ therapy. The impact on the ‘cardio-renal continuum’ exerted by SGLTs-I was also noted in non-diabetic patients with heart failure and reduced or preserved ventricular function and different levels of renal function. These drugs reduced re-hospitalization, CV mortality, and progression to end-stage renal disease. These clinical acquisitions, implemented by Scientific Societies, have led to a change in the therapeutic approach to diabetic cardio-renal disease. Although metformin still represents a valid therapeutic option to be offered particularly to ‘naïve’ diabetic patients without previous cardio-renal events, SGLTs-I and/or GLP1-RAs emerge as ‘first-line’ drugs in diabetic patients with previous CV events, or at high CV risk, without having to request ‘on board’ metformin therapy.
    Type of Medium: Online Resource
    ISSN: 1520-765X , 1554-2815
    URL: Article
    DOI: 10.1093/eurheartjsupp/suad098
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
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  • 6
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    Cardiac complications of COVID-19 vaccination: now we know more
    Oxford University Press (OUP) ; 2022
    In:  European Heart Journal Supplements Vol. 24, No. Supplement_I ( 2022-11-12), p. I190-I196
    Details
    In: European Heart Journal Supplements, Oxford University Press (OUP), Vol. 24, No. Supplement_I ( 2022-11-12), p. I190-I196
    Abstract: The proliferation of good quality observational studies on the potential adverse effects of COVID-19 vaccination has greatly increased our knowledge on myocarditis and pericarditis, and also, more recently, on arterial hypertension. According to some recent studies, the incidence of a significant increase in blood pressure after COVID-19 vaccination is about 3.2% (95% CI: 1.62–6.21). The incidence of serious hypertensive emergencies or stage III hypertension has been reported as 0.6%. It is well known that the ‘spike protein’ of the Sars-CoV-2 virus, the synthesis of which is induced by vaccines, binds to ACE2 receptors, inducing their migration towards the inside of the cell. This would result in a lack of ACE2 activity on cell surfaces and therefore a relative deficiency of angiotensin1-7 with a relative excess of angiotensin II, which could explain, at least in part, the blood pressure increases. Regarding myo-pericarditis, there is evidence that the advantages of COVID-19 vaccination over non-vaccination remain preponderant in terms of prevented hospitalizations and serious complications of COVID-19, compared with the risk of developing myocarditis. In the age group most at risk of COVID-19 vaccine myocarditis (12–29 years), for every 100 000 vaccinated, compared to about four more cases of myocarditis we have 56 fewer hospitalizations, 13.8 admissions to intensive care and 0.6 fewer deaths. Several studies have shown that post vaccine myocarditis/pericarditis are generally short-lasting phenomena with favourable clinically course.
    Type of Medium: Online Resource
    ISSN: 1520-765X , 1554-2815
    URL: Article
    DOI: 10.1093/eurheartjsupp/suac093
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
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  • 7
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    Do angiotensin II receptor blockers increase the risk of myocardial infarction?
    Oxford University Press (OUP) ; 2005
    In:  European Heart Journal Vol. 26, No. 22 ( 2005-11-01), p. 2381-2386
    Details
    In: European Heart Journal, Oxford University Press (OUP), Vol. 26, No. 22 ( 2005-11-01), p. 2381-2386
    Type of Medium: Online Resource
    ISSN: 1522-9645 , 0195-668X
    URL: Article
    DOI: 10.1093/eurheartj/ehi445
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2005
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  • 8
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    512 Long-term survival in patients with post-operative atrial fibrillation after cardiac surgery: analysis from a prospective-cohort study
    Oxford University Press (OUP) ; 2021
    In:  European Heart Journal Supplements Vol. 23, No. Supplement_G ( 2021-12-08)
    Details
    In: European Heart Journal Supplements, Oxford University Press (OUP), Vol. 23, No. Supplement_G ( 2021-12-08)
    Abstract: Post-operative atrial fibrillation (POP AF) is frequent in patients who undergo cardiac surgery. However, its prognostic impact in the long-term remains unclear. Methods and results We followed for an average of 10 ± 3 years 1386 patients who underwent a variety of cardiac surgical procedures (cardiac transplantation and surgery for heart failure included) while they were in sinus rhythm. Among 1178 patents without a history of AF, 726 (62%) did not develop AF during the entire duration of the study and 452 (38%) developed new-onset POP AF during the first 30 peri-operative days after heart surgery. Other 125 patients with a positive history of paroxysmal or persistent AF were in sinus rhythm at the time of surgery and 87 of them (70%) developed POP AF. Finally, 83 patients had permanent AF when they underwent surgery. All-cause mortality was the primary outcome of the study. We tested the associations of potential determinants with all-cause mortality using univariable and multivariable statistical analyses by means of Cox proportional hazard models. Overall, 473 patients (34%) died during a long-term follow-up. Compared with patients who never developed AF, neither the patients with new-onset POP AF [adjusted HR = 1.31 (95% CI: 0.90–1.89); P = 0.1609], nor those with history of AF at the time of surgery (adjusted HR = 1.33, 95% CI: 0.71–2.49; P = 0.3736) showed a significantly increased risk of mortality (Figure 1). In new-onset POP AF patients, oral anticoagulation was not associated with mortality [adjusted HR = 1.13 (95% CI: 0.83–1.54), P = 0.4299] . Conclusions In this huge prospective cohort of patients who underwent different types of heart surgery, POP AF was not associated with an increased risk of mortality. In this setting, the role of long-term anticoagulation remains unclear.
    Type of Medium: Online Resource
    ISSN: 1520-765X , 1554-2815
    URL: Article
    DOI: 10.1093/eurheartj/suab127.017
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
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  • 9
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    Certainties fading away: β-blockers do not worsen chronic obstructive pulmonary disease
    Oxford University Press (OUP) ; 2021
    In:  European Heart Journal Supplements Vol. 23, No. Supplement_E ( 2021-10-09), p. E172-E176
    Details
    In: European Heart Journal Supplements, Oxford University Press (OUP), Vol. 23, No. Supplement_E ( 2021-10-09), p. E172-E176
    Abstract: For many years, β-blockers have been considered contraindicated in patients with heart failure (HF) and in those with bronchial asthma or even chronic obstructive pulmonary disease (COPD) although without clear evidence of asthma. Today, despite overwhelming evidence of the usefulness of β-blockers, especially in HF with reduced left ventricular ejection fraction (HFrEF), and in ischaemic heart disease, some reluctance persists in using these drugs when COPD coexists. Such resistance is due to the fear that a possible worsening of bronchospasm induced by β-blockers could induce negative effects greater than the benefits. The Guidelines of the European Society of Cardiology clearly suggest that: (i) implantation of a cardiac defibrillator (ICD) are not contraindicated in COPD without clear evidence of bronchial asthma; (ii) β-blockers are only ‘relatively’ contraindicated when there is certainty of bronchial asthma with a documented bronchodilator response to the β2 stimulant. Therefore, bronchial asthma is not an absolute contraindication to β-blockers. The cardiologist should not limit the diagnosis of COPD to clinical suspicion, but should rely on a spirometry examination associated with any bronchodilation tests. In any case, selective β1 blockers are preferred, starting at a basic dose, which ensure a better dilator response to bronchodilators and in any case cause less bronchospasm than non-selective β-blockers. Unfortunately, there is still some reluctance to the use of β-blockers in patients with COPD associated with HF, which should be eliminated.
    Type of Medium: Online Resource
    ISSN: 1520-765X , 1554-2815
    URL: Article
    DOI: 10.1093/eurheartj/suab116
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
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  • 10
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    African Ancestry and Uncontrolled Hypertension: Current Knowledge and Future Perspectives
    Oxford University Press (OUP) ; 2021
    In:  American Journal of Hypertension Vol. 34, No. 12 ( 2021-12-01), p. 1255-1258
    Details
    In: American Journal of Hypertension, Oxford University Press (OUP), Vol. 34, No. 12 ( 2021-12-01), p. 1255-1258
    Type of Medium: Online Resource
    ISSN: 0895-7061 , 1941-7225
    URL: Article
    DOI: 10.1093/ajh/hpab148
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
    detail.hit.zdb_id: 1479505-X
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